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<title xml:lang="en">The effect of exposure to wood smoke on outcomes of childhood pneumonia in Botswana</title>
<author>
<name sortKey="Kelly, Matthew S" sort="Kelly, Matthew S" uniqKey="Kelly M" first="Matthew S." last="Kelly">Matthew S. Kelly</name>
<affiliation>
<nlm:aff id="A1">Botswana-UPenn Partnership, Gaborone, Botswana</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A4">Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Wirth, Kathleen E" sort="Wirth, Kathleen E" uniqKey="Wirth K" first="Kathleen E." last="Wirth">Kathleen E. Wirth</name>
<affiliation>
<nlm:aff id="A5">Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Madrigano, Jaime" sort="Madrigano, Jaime" uniqKey="Madrigano J" first="Jaime" last="Madrigano">Jaime Madrigano</name>
<affiliation>
<nlm:aff id="A6">Department of Environmental and Occupational Health, Rutgers School of Public Health, Piscataway, New Jersey, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Feemster, Kristen A" sort="Feemster, Kristen A" uniqKey="Feemster K" first="Kristen A." last="Feemster">Kristen A. Feemster</name>
<affiliation>
<nlm:aff id="A2">Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A3">Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A7">Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Cunningham, Coleen K" sort="Cunningham, Coleen K" uniqKey="Cunningham C" first="Coleen K." last="Cunningham">Coleen K. Cunningham</name>
<affiliation>
<nlm:aff id="A4">Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Arscott Mills, Tonya" sort="Arscott Mills, Tonya" uniqKey="Arscott Mills T" first="Tonya" last="Arscott-Mills">Tonya Arscott-Mills</name>
<affiliation>
<nlm:aff id="A1">Botswana-UPenn Partnership, Gaborone, Botswana</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A7">Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Boiditswe, Sefelani" sort="Boiditswe, Sefelani" uniqKey="Boiditswe S" first="Sefelani" last="Boiditswe">Sefelani Boiditswe</name>
<affiliation>
<nlm:aff id="A1">Botswana-UPenn Partnership, Gaborone, Botswana</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Shah, Samir S" sort="Shah, Samir S" uniqKey="Shah S" first="Samir S." last="Shah">Samir S. Shah</name>
<affiliation>
<nlm:aff id="A8">Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Finalle, Rodney" sort="Finalle, Rodney" uniqKey="Finalle R" first="Rodney" last="Finalle">Rodney Finalle</name>
<affiliation>
<nlm:aff id="A2">Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A7">Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Steenhoff, Andrew P" sort="Steenhoff, Andrew P" uniqKey="Steenhoff A" first="Andrew P." last="Steenhoff">Andrew P. Steenhoff</name>
<affiliation>
<nlm:aff id="A1">Botswana-UPenn Partnership, Gaborone, Botswana</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A3">Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A7">Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
</author>
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<idno type="wicri:source">PMC</idno>
<idno type="pmid">25686146</idno>
<idno type="pmc">4352146</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352146</idno>
<idno type="RBID">PMC:4352146</idno>
<idno type="doi">10.5588/ijtld.14.0557</idno>
<date when="2015">2015</date>
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<title xml:lang="en" level="a" type="main">The effect of exposure to wood smoke on outcomes of childhood pneumonia in Botswana</title>
<author>
<name sortKey="Kelly, Matthew S" sort="Kelly, Matthew S" uniqKey="Kelly M" first="Matthew S." last="Kelly">Matthew S. Kelly</name>
<affiliation>
<nlm:aff id="A1">Botswana-UPenn Partnership, Gaborone, Botswana</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A4">Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Wirth, Kathleen E" sort="Wirth, Kathleen E" uniqKey="Wirth K" first="Kathleen E." last="Wirth">Kathleen E. Wirth</name>
<affiliation>
<nlm:aff id="A5">Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Madrigano, Jaime" sort="Madrigano, Jaime" uniqKey="Madrigano J" first="Jaime" last="Madrigano">Jaime Madrigano</name>
<affiliation>
<nlm:aff id="A6">Department of Environmental and Occupational Health, Rutgers School of Public Health, Piscataway, New Jersey, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Feemster, Kristen A" sort="Feemster, Kristen A" uniqKey="Feemster K" first="Kristen A." last="Feemster">Kristen A. Feemster</name>
<affiliation>
<nlm:aff id="A2">Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A3">Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A7">Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Cunningham, Coleen K" sort="Cunningham, Coleen K" uniqKey="Cunningham C" first="Coleen K." last="Cunningham">Coleen K. Cunningham</name>
<affiliation>
<nlm:aff id="A4">Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Arscott Mills, Tonya" sort="Arscott Mills, Tonya" uniqKey="Arscott Mills T" first="Tonya" last="Arscott-Mills">Tonya Arscott-Mills</name>
<affiliation>
<nlm:aff id="A1">Botswana-UPenn Partnership, Gaborone, Botswana</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A7">Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Boiditswe, Sefelani" sort="Boiditswe, Sefelani" uniqKey="Boiditswe S" first="Sefelani" last="Boiditswe">Sefelani Boiditswe</name>
<affiliation>
<nlm:aff id="A1">Botswana-UPenn Partnership, Gaborone, Botswana</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Shah, Samir S" sort="Shah, Samir S" uniqKey="Shah S" first="Samir S." last="Shah">Samir S. Shah</name>
<affiliation>
<nlm:aff id="A8">Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Finalle, Rodney" sort="Finalle, Rodney" uniqKey="Finalle R" first="Rodney" last="Finalle">Rodney Finalle</name>
<affiliation>
<nlm:aff id="A2">Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A7">Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Steenhoff, Andrew P" sort="Steenhoff, Andrew P" uniqKey="Steenhoff A" first="Andrew P." last="Steenhoff">Andrew P. Steenhoff</name>
<affiliation>
<nlm:aff id="A1">Botswana-UPenn Partnership, Gaborone, Botswana</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A3">Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A7">Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA</nlm:aff>
</affiliation>
</author>
</analytic>
<series>
<title level="j">The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease</title>
<idno type="ISSN">1027-3719</idno>
<idno type="eISSN">1815-7920</idno>
<imprint>
<date when="2015">2015</date>
</imprint>
</series>
</biblStruct>
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</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<sec id="S1">
<title>Setting</title>
<p id="P1">Tertiary hospital in Gaborone, Botswana.</p>
</sec>
<sec id="S2">
<title>Objective</title>
<p id="P2">To examine whether exposure to wood smoke worsens outcomes of childhood pneumonia.</p>
</sec>
<sec id="S3">
<title>Design</title>
<p id="P3">Prospective cohort study of children 1-23 months of age meeting clinical criteria for pneumonia. Household use of wood as a cooking fuel was assessed during a face-to-face questionnaire with caregivers. We estimated crude and adjusted risk ratios (RR) and 95% confidence intervals (CI) for treatment failure at 48 hours by household use of wood as a cooking fuel. We assessed for effect modification by age (1-5 vs. 6-23 months) and malnutrition (none vs. moderate vs. severe).</p>
</sec>
<sec id="S4">
<title>Results</title>
<p id="P4">Median age of the 284 enrolled children was 5.9 months and 17% had moderate or severe malnutrition. Ninety-nine (35%) children failed treatment at 48 hours and 17 (6%) died. In multivariable analyses, household use of wood as a cooking fuel increased the risk of treatment failure at 48 hours (RR: 1.44, 95% CI: 1.09-1.92,
<italic>P</italic>
=0.01). This association differed by child nutritional status (
<italic>P</italic>
=0.02), with a detrimental effect observed only among children with no or moderate malnutrition.</p>
</sec>
<sec id="S5">
<title>Conclusions</title>
<p id="P5">Exposure to wood smoke worsens outcomes from childhood pneumonia. Efforts to prevent exposure to smoke from unprocessed fuels may improve pneumonia outcomes among children.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article">
<pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-journal-id">9706389</journal-id>
<journal-id journal-id-type="pubmed-jr-id">20773</journal-id>
<journal-id journal-id-type="nlm-ta">Int J Tuberc Lung Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">Int. J. Tuberc. Lung Dis.</journal-id>
<journal-title-group>
<journal-title>The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease</journal-title>
</journal-title-group>
<issn pub-type="ppub">1027-3719</issn>
<issn pub-type="epub">1815-7920</issn>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">25686146</article-id>
<article-id pub-id-type="pmc">4352146</article-id>
<article-id pub-id-type="doi">10.5588/ijtld.14.0557</article-id>
<article-id pub-id-type="manuscript">NIHMS665256</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Article</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>The effect of exposure to wood smoke on outcomes of childhood pneumonia in Botswana</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Kelly</surname>
<given-names>Matthew S.</given-names>
</name>
<degrees>MD, MPH</degrees>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Wirth</surname>
<given-names>Kathleen E.</given-names>
</name>
<degrees>ScD</degrees>
<xref ref-type="aff" rid="A5">5</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Madrigano</surname>
<given-names>Jaime</given-names>
</name>
<degrees>ScD, MPH</degrees>
<xref ref-type="aff" rid="A6">6</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Feemster</surname>
<given-names>Kristen A.</given-names>
</name>
<degrees>MD, MPH, MSHPR</degrees>
<xref ref-type="aff" rid="A2">2</xref>
<xref ref-type="aff" rid="A3">3</xref>
<xref ref-type="aff" rid="A7">7</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Cunningham</surname>
<given-names>Coleen K.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Arscott-Mills</surname>
<given-names>Tonya</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A7">7</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Boiditswe</surname>
<given-names>Sefelani</given-names>
</name>
<degrees>BNSc</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Shah</surname>
<given-names>Samir S.</given-names>
</name>
<degrees>MD, MSCE</degrees>
<xref ref-type="aff" rid="A8">8</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Finalle</surname>
<given-names>Rodney</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A2">2</xref>
<xref ref-type="aff" rid="A7">7</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Steenhoff</surname>
<given-names>Andrew P.</given-names>
</name>
<degrees>MBBCh, DCH</degrees>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
<xref ref-type="aff" rid="A3">3</xref>
<xref ref-type="aff" rid="A7">7</xref>
</contrib>
</contrib-group>
<aff id="A1">
<label>1</label>
Botswana-UPenn Partnership, Gaborone, Botswana</aff>
<aff id="A2">
<label>2</label>
Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA</aff>
<aff id="A3">
<label>3</label>
Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA</aff>
<aff id="A4">
<label>4</label>
Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA</aff>
<aff id="A5">
<label>5</label>
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA</aff>
<aff id="A6">
<label>6</label>
Department of Environmental and Occupational Health, Rutgers School of Public Health, Piscataway, New Jersey, USA</aff>
<aff id="A7">
<label>7</label>
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA</aff>
<aff id="A8">
<label>8</label>
Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA</aff>
<author-notes>
<corresp id="CR1">Corresponding Author: Matthew S. Kelly, MD Box 3499, Duke University Medical Center, Durham, NC 27710 Phone: 1-(919) 530-0712
<email>matthew.kelly@duke.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted">
<day>21</day>
<month>2</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="ppub">
<month>3</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="pmc-release">
<day>01</day>
<month>3</month>
<year>2016</year>
</pub-date>
<volume>19</volume>
<issue>3</issue>
<fpage>349</fpage>
<lpage>355</lpage>
<pmc-comment>elocation-id from pubmed: 10.5588/ijtld.14.0557</pmc-comment>
<abstract>
<sec id="S1">
<title>Setting</title>
<p id="P1">Tertiary hospital in Gaborone, Botswana.</p>
</sec>
<sec id="S2">
<title>Objective</title>
<p id="P2">To examine whether exposure to wood smoke worsens outcomes of childhood pneumonia.</p>
</sec>
<sec id="S3">
<title>Design</title>
<p id="P3">Prospective cohort study of children 1-23 months of age meeting clinical criteria for pneumonia. Household use of wood as a cooking fuel was assessed during a face-to-face questionnaire with caregivers. We estimated crude and adjusted risk ratios (RR) and 95% confidence intervals (CI) for treatment failure at 48 hours by household use of wood as a cooking fuel. We assessed for effect modification by age (1-5 vs. 6-23 months) and malnutrition (none vs. moderate vs. severe).</p>
</sec>
<sec id="S4">
<title>Results</title>
<p id="P4">Median age of the 284 enrolled children was 5.9 months and 17% had moderate or severe malnutrition. Ninety-nine (35%) children failed treatment at 48 hours and 17 (6%) died. In multivariable analyses, household use of wood as a cooking fuel increased the risk of treatment failure at 48 hours (RR: 1.44, 95% CI: 1.09-1.92,
<italic>P</italic>
=0.01). This association differed by child nutritional status (
<italic>P</italic>
=0.02), with a detrimental effect observed only among children with no or moderate malnutrition.</p>
</sec>
<sec id="S5">
<title>Conclusions</title>
<p id="P5">Exposure to wood smoke worsens outcomes from childhood pneumonia. Efforts to prevent exposure to smoke from unprocessed fuels may improve pneumonia outcomes among children.</p>
</sec>
</abstract>
</article-meta>
</front>
</pmc>
</record>

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